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Introduction/Background Multiple sclerosis often results in upper limb dysfunction which significantly affects patients’ quality of life. However, little support is currently proposed for this deficit. Fampridine-PR is validated to improve walking speed but only few studies indicate that this drug may also be effective on upper limb function, with no detailed functional movement analysis. The aim of this study is to assess efficacy of fampridine-PR on improving grasping abilities in persons with Multiple Sclerosis (PwMS) by using a global analysis including both clinical and kinematic criteria. Material and method We included 14 consecutive PwMS with EDSS > 5 and we performed Jebsen Hand Function Test (JHFT) before treatment and under treatment. Patients showing a consistent improvement at D14 ( n = 11 patients showing at least 12% reduction between D0 and D14) continued the treatment and the JHFT score were measured after 30 and 90 days under treatment. We also quantified upper force using dynamometers after 14, 30 and 90 days of treatment. In addition 3D kinematic analyses (grasping a glass) were realized with each arm on each assessment. Results JHFT score dropped from day 0 to day 14 by more than 20% and remained stable up to day 90. Individual analysis highlighted that improvement of JHFT score varied from 12.4% to 59.3% from initial score. The evolution of testing score followed the same trend. The hand dynanometer score remained heterogeneous. The kinematic analysis showed a better opening of the grip and a smoothing of the arm movement with less velocity peaks. Conclusion The results suggest that Fampridine-PR can significantly improve grasping function during at least the 90 days of our follow-up. [ABSTRACT FROM AUTHOR]

Introduction/Background One objective of acute stroke rehabilitation is restoration and improvement of arm use. The aim of this study is to determine feasibility and efficiency of additional exercise in acute stroke inpatient rehabilitation facility (IRF) using the Armeo-Spring ® (ARMEO) robot vs. therapist supervised Table Top (TT) exercises. Material and method Blinded, randomized, study using TT or ARMEO in addition to 3 hours of 1:1 required therapy. Participants with unilateral hemiparesis ≥ 18 years with a minimum Fugl-Meyer Assessment score of 8/66 or Modified Ashworth Scale score of < 3 after acute stroke. Outcome measures Number of treatment sessions; serious/adverse events (S/AEs); Functional Independence Measure (FIM) efficiency; and Modified Borg Rating of therapist Perceived Exertion Scale (RPE). Results Thirty-six participants enrolled in the study thus far. ARMEO participants on average had more training days (6.6) than TT (5.9); number of training days was not statistically different ( P = .59). FIM efficiency was not significantly different. There was statistically significant median decrease in Borg from last day of training to the first day of training in both ARMEO or TT groups, P < .005. Five ARMEO participants and eight TT participants reported AEs. No SAEs were reported. Conclusion Acute stroke patients are able to tolerate and participate in an additional functional exercise program in an IRF without SAEs. Although the training groups did not yet yield statistical significance, FIM efficiency improved and therapist effort decreased. This study supports early recovery in acute stroke rehabilitation and ARMEO was preferred training mode and with good patient satisfaction. [ABSTRACT FROM AUTHOR]

Opinion/Feedback Our unit has been providing antenatal consultations for 30 years following the discovery of limb malformation with the fetus. Each of these consultations is specific and carried out by a multi-professional team. It requires a physical and rehabilitation doctor, an orthopedic surgeon, an occupational therapist for upper limb malformation, a physiotherapist for lower malformation and a psychologist. This multidisciplinary consultation is unique because of each pregnancy story, because of each patient life story but also because of the words used by the sonologist when announcing the diagnosis. We deal with couples shocked by the prenatal diagnosis. We help them get acceptance of the child to be born and to forget about their imaginary child. Medical information is often perceived as being “a surfeit of information” difficult to handle by the couple stunned by the overwhelming diagnosis. We must stress that it is critical to not only have a good medical description of the malformations and potential treatments but also a good psychological support (parents personal life story, self-defense mechanism, guilt feeling). The ethical aspect of this consultation is also important. Team members must be as neutral as possible in their assessments in order to let the couple take the final decision: the continuation of the pregnancy or a request of voluntary termination of pregnancy. These prenatal consultations highlight the importance of the multidisciplinary global care. [ABSTRACT FROM AUTHOR]

Objective The Modified Frenchay Scale (MFS) measures active upper limb function in hemiparesis based on a video review of 10 everyday living tasks, each rated on a 10-point visual analogic scale. Six tasks are bimanual and four are unimanual performed with the paretic hand. We measured intra- and inter-rater reliability of MFS in hemiparetic patients among trained raters. Material/patients and methods After a group training session consisting in reviewing and commenting upon ten patient videos, 10 raters assessed the videos of 10 adults with chronic hemiparesis (age 52 ± 13, mean ± SD) on two occasions one week apart. Intra- and inter-rater reliability was assessed using interclass correlation coefficients, mean intra- and inter-rater differences, coefficients of variation between raters and the agreement frequency procedure, agreement being defined as a difference equal or less than 0.5 between two individual ratings. Results For the overall MFS scores, mean intra- and inter-rater ICC coefficients were respectively 0.99 [0.95; 1.00] (mean [95%CI]) and 0.98 [0.98; 1.00]. The mean intra-rater score difference between two ratings one-week apart was 0.26 ± 0.08 and the mean inter-rater standard deviation was 0.61 ± 0.17. Inter-rating differences of less than 0.5 were found in 86% of cases of intra-rater comparisons and in 52% of inter-rater comparisons. Mean inter-rater coefficient of variation was 0.11 ± 0.03. Discussion - conclusion After a group training session in using the scale, the Modified Frenchay Scale has excellent intra- and inter-rater reliability. [ABSTRACT FROM AUTHOR]

Background Following a cerebrovascular accident (CVA or stroke), many patients experience learned non-use of the paretic arm (LNU UL ). One part of LNU is explained by the fact that the patient moves his trunk forward instead of extending his arm to reach a given object, even though he is capable of extending his arm. This is because using the trunk for this task demands less energy and concentration than using the paretic arm. This phenomenon is known to be detrimental to neuroplasticity and recovery. Objective The aim of this study is to quantify this part of learned non-use of the paretic upper limb during a hand-reaching task using 3D movement analysis. Methods Thirty-four post-supratentorial stroke participants were asked to reach a cone placed in front of them at 80% of their arm length. The reaching movement was repeated 5 times with the paretic hand, and then 5 times with the less-impaired hand. This sequence was first performed with the trunk free, then with the trunk restrained. Learned non-use of the upper limb (LNU UL ) was obtained from the difference of the amount of trunk compensation between the free trunk condition and the restrained trunk condition. Results LNU UL was significantly higher for the paretic hand, with individual values ranging from 1 to 43%, and one half of the patients with a LNU UL higher than 15%. Discussion/conclusion This quantification of LNU UL can be used to objectively pinpoint patients who have maladaptive trunk compensation and need specific trunk rehabilitation. It can be also used for monitoring the rehabilitation progress. This quantification of LNU UL may guide upper limb rehabilitation towards more optimal motor recovery avoiding maladaptive trunk compensation and its consequences on neuroplasticity. Considering LNU U could advance both theoretical and practical knowledge about the recovery of arm use after a CVA. [ABSTRACT FROM AUTHOR]